Medicare is a federal health insurance program for people 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. There are a few different Medicare plans, including Original Medicare, Part A (Hospital Insurance) and Part B (Medical Insurance). Another option is a Medicare Advantage plan (Part C), which we’ll be discussing in-depth today.
Medicare Advantage plans are an increasingly popular alternative to traditional Medicare. These plans can be a great way to get health insurance, as they offer many benefits that Original Medicare doesn’t, such as lower out-of-pocket costs and broader coverage. However, Medicare Advantage may not be the best option for everyone, so you should understand what these plans entail before enrolling.
Read through the article to learn what Medicare Advantage plans are, what they cover, and some of the benefits of enrolling in one. We’ll also answer some common questions about Medicare Advantage, such as when you can sign up and how much it costs. If you’re considering enrolling in a Medicare Advantage plan, you’ll find this information helpful.
What Are Medicare Advantage Plans?
As we mentioned, Medicare Advantage plans, also called “Part C” or “MA Plans,” are an alternative to Original Medicare (Part A and B). These plans are offered by private insurance companies that contract with Medicare. If you sign up for an Advantage plan, you’ll still have Original Medicare coverage, but the private insurance company will provide your benefits instead.
Enrolling in a Medicare Advantage plan requires beneficiaries to use the plan’s network of providers, though some plans offer out-of-network coverage at an additional cost. There are several types of Medicare Advantage plans, including Private Fee-For-Service (PFFS) Plans and Medical Savings Account (MSA) Plans. We’ll discuss each of these in more detail later on.
What Does Medicare Advantage Cover?
Medicare Advantage plans must include all of the benefits covered under Original Medicare. Part A’s benefits are:
- Hospital care
- Skilled nursing facility care
- Nursing home care
- Home health care
- Hospice care
On the other hand, Part B’s benefits are:
- Preventive services (including screenings, vaccinations, and annual wellness visits)
- Doctor’s office visits (including specialists)
- Outpatient care (including surgery, X-rays, and lab tests)
Some plans offer prescription drug coverage (Part D), but not all of them. If you’re interested in Part D coverage, check before enrolling. The specific benefits offered by each plan can vary depending on your state.
What Does Medicare Advantage Not Cover?
There are a few things that Medicare Advantage doesn’t cover, but you may be allowed to tailor your plan to include extra benefits. Some of the things not typically covered by Advantage plans are:
- Long-term care
- Dental care
- Vision care
- Hearing aids
- Private duty nursing
- Acupuncture
- Chiropractic services
Because this coverage isn’t required, plans can choose to exclude it. Be aware of these potential limitations when considering enrolling in a Medicare Advantage plan. Otherwise, you may be surprised when your plan doesn’t cover something you thought it would.
The Benefits Of Medicare Advantage Compared To Other Plans
There are many advantages of signing up for a Medicare Advantage plan, as opposed to other types of Medicare plans:
- Lower Out-Of-Pocket Costs: Most Medicare Advantage plans have lower premiums than Original Medicare; this can save you significant money on your healthcare costs.
- Annual Out-Of-Pocket Maximum: Generally, Medicare Advantage plans have an annual out-of-pocket maximum, or the most you’d have to pay for covered health care services in a year. Once you reach this amount, the plan would pay 100% of the costs for covered services.
- More Complete Coverage: While this isn’t always the case, some Medicare Advantage plans offer additional coverage for things like dental, vision, hearing, and drugs. These benefits aren’t available with Original Medicare.
- Better Coordination Of Care: Many Medicare Advantage plans offer extra services to help coordinate your care, such as case management and disease management programs.
Medicare Advantage Eligibility
To be eligible for a Medicare Advantage plan, you must:
- Be enrolled in both Parts A and B of Medicare.
- Live in the service area of the plan you’re interested in.
End-Stage Renal Disease patients may also be eligible for Medicare Advantage. If you meet both requirements, you can enroll in a Medicare Advantage plan during one of the following enrollment periods:
- Initial Enrollment Period: This period lasts for seven months, and it’s when you first become eligible for Medicare (Part A or B). It begins three months before your 65th birthday, includes your birth month, and concludes three months after you turn 65.
- Annual Open Enrollment Period: October 15 – December 7
- Medicare Advantage Open Enrollment Period: January – March. Unlike the Annual Open Enrollment Period, you can only make changes to your Medicare Advantage plan during this time. You can’t switch from Original Medicare to a Medicare Advantage plan or vice versa.
- Special Enrollment Period: If you have a change in your circumstances that qualify you for a Special Enrollment Period (SEP), you may be able to enroll in or switch your Medicare Advantage plan outside of the Annual Open Enrollment Period. Some examples of qualifying life changes are moving to a new coverage area, losing other creditable coverage, or gaining eligibility for Medicaid.
The Process Of Enrolling In Medicare Advantage
Signing up for Medicare Advantage is similar to enrolling in other types of health insurance. First, you’ll need to research the different plans available in your area and compare the benefits of each one. Once you’ve decided on a plan, you should visit the plan’s website to see if you can apply online. You’ll need to print out and complete an application form. You can also apply by phone by calling 1-800-MEDICARE (1-800-633-4227) or the specific plan’s customer service number.
After completing your application, you’ll need to submit it to the plan along with any required documentation, such as your Medicare number and the date your Part A or B coverage began. Once your application is processed, you’ll receive a confirmation letter from the plan with your enrollment information. You should keep this letter safe so you can reference it in the future if you have any questions about your coverage.
Medicare Advantage Costs
The costs of Medicare Advantage plans vary depending on your chosen plan and your state. In general, you can expect to pay the following:
- Monthly Premium: Most people who enroll in a Medicare Advantage plan will have to pay a monthly premium in addition to their Part B premium. In 2022, the Part B standard monthly premium is $170.10.
- Deductible: Many Medicare Advantage plans have a deductible, which is the amount you have to pay for covered health care treatments before your plan begins to reimburse you.
- Copayments And Coinsurance: After you meet your deductible, you may still have to pay copayments or coinsurance for covered healthcare services.
Understanding Medicare Medical Savings Account Plans
A Medicare Medical Savings Account Plan, also known as a Medicare MSA Plan, is a type of Medicare Advantage Plan that integrates a high-deductible health plan with a special savings account. Its main benefit is that it can help you save on healthcare costs. MSA plans don’t charge monthly premiums, but you’ll still have to pay for your Part B premium. Medicare MSA Plans have two parts:
- High-Deductible Health Plan: It’s a health insurance plan with a high deductible. You pay the total cost of covered medical expenses until you reach your deductible. After that, the plan pays for a portion of your covered medical expenses.
- Savings Account: This special savings account is used to pay for medical expenses. You can keep the funds in the account, even if you don’t use them all in a given year.
Understanding Medicare Advantage Private Fee-For-Service Plans
A Medicare Advantage Private Fee-For-Service Plan, or Medicare PFFS Plan, gives you the flexibility to see any doctor or other healthcare provider who accepts the terms and conditions of your plan. These plans don’t have network restrictions, and you’re not required to get a referral from your primary care doctor to see a specialist.
The plan will decide how much it will pay the provider and how much you’ll have to pay. It will inform you of your cost-sharing responsibility in the “Evidence of Coverage” and “Annual Notice of Change” documents. You should always check with the provider to ensure they agree to the plan’s payment terms before you receive care; some may decide not to treat you even if they’ve previously seen you.
Nesso Senior Benefits – Reliable And Reputable Medicare Advisors
If you’re looking for a trustworthy Medicare advisor in Connecticut, look no further than Nesso Senior Benefits. We’re a team of trustworthy insurance agents who’re experts in all things Medicare. We’ll help you compare plans and find the one that’s right for you. Our objective is to assist you in making informed decisions for the years ahead, ensuring your plan will work for your evolving needs.
We’re part of the Nesso Group, which guides individuals and businesses in multiple areas of expertise, including Medicare, insurance, wealth, and more. We offer comprehensive solutions to alleviate stress and elevate success. Our clients benefit from service integration because our team gains a panoramic view of their needs and goals. Contact us today, and let’s work together with your best interests in mind.
